Project description:Background and study aims Small colorectal polyps are removed by various methods, including cold snare polypectomy (CSP), hot snare polypectomy (HSP), and underwater endoscopic mucosal resection (UEMR), but the indications for using these methods are unclear. We retrospectively assessed the efficacy of CSP, HSP, and UEMR for small polyps, focusing on the depth of the resected specimens. Patients and methods Outpatients with non-pedunculated small polyps (endoscopically diagnosed as 6 to 9 mm), resected by two endoscopists between July 2019 and September 2020, were enrolled. We histologically evaluated the specimens resected via CSP, HSP, and UEMR. The main outcome was the containment rate of the muscularis mucosa (MM) and submucosa (SM) tissues. Results Forty polyps resected via CSP (n = 14), HSP (n = 12), or UEMR (n = 14) were enrolled after excluding 13 polyps with resection depths that were difficult to determine. The rates of specimens containing MM and SM tissue differed significantly (57 % and 29 % for CSP, 92 % and 83 % for HSP, and 100 % and 100 % for UEMR, respectively ( P = 0.005 for MM and P < 0.001 for SM tissue). Multiple logistic regression analysis showed UEMR was an independent factor relating to the containment of SM tissue. The thickness of SM tissue by CSP, HSP, and UEMR were 52 μm, 623 μm, and 1119 μm, respectively ( P < 0.001). The thickness by CSP was significantly less than those by HSP and UEMR ( P < 0.001, Bonferroni correction). Conclusions UEMR could be the best method to contain SM tissue without injection. Further studies are needed to evaluate the indication of UEMR for small polyps.

| S-EPMC9106413 | biostudies-literature

Histological outcomes between hot and cold snare polypectomy for small colorectal polyps.

Project description:To compare the complete resection rate of hot and cold snare polypectomy for small colorectal polyps.We retrospectively reviewed the medical records of 233 consecutive patients with 461 colorectal polyps up to 10 mm in diameter that were treated by hot or cold snare polypectomy between April 2014 and August 2016. Lesions treated by hot snare polypectomy (n = 137) and cold snare polypectomy (n = 324) were compared. The histological complete resection rates were evaluated between the two groups. We analyzed the relationship between factors for complete resection and clinical factors using multivariate analysis.There was a significantly higher complete resection rate in hot snare polypectomy than in cold snare polypectomy (70.5% vs. 47.3%; P < 0.001). In the analysis of subgroups categorized according to polyp size, the complete resection rate for hot snare polypectomy was significantly higher than that for cold snare polypectomy among polyps ≥6 mm (69.0% vs. 43.5%; P < 0.001). Among polyps ≤5 mm, no significant difference regarding the complete resection rate was observed between the methods (81.3% vs. 53.4%; P = 0.057). There was no significant difference in the incidence of adverse events between the two groups. Multivariate analysis revealed that using hot snare polypectomy (odds ratio 3.03; P < 0.001), small lesion size (odds ratio 1.57; P = 0.049), and lesion location in the left colon (odds ratio 1.73; P = 0.007) were independent factors for complete resection.Hot snare polypectomy provides a higher complete resection rate than does cold snare polypectomy for larger (6-10 mm) subcentimeter colorectal polyps.

| S-EPMC5539679 | biostudies-other

Cold snare polypectomy for polyp adjacent to colonic diverticulum.

Project description: Not available

| S-EPMC6004032 | biostudies-literature

A simple and cost-effective method: piecemeal cold snare polypectomy without injection for a large sessile serrated lesion ≥20 mm.

Project description: Not available

| S-EPMC7332670 | biostudies-literature

Comparative meta-analysis of cold snare polypectomy and endoscopic mucosal resection for colorectal polyps: assessing efficacy and safety.

Project description:Colorectal polyps are commonly treated with surgical procedures, with cold snare polypectomy (CSP) and endoscopic mucosal resection (EMR) being the two most prevalent techniques. This meta-analysis (PROSPERO ID: CRD42022336152) aimed to compare the efficacy and safety of CSP and EMR in the management of colorectal polyps. Comprehensive searches were conducted in PubMed, Embase, CINAHL, Web of Science, and Cochrane Library databases, covering publications up until June 2024. The primary outcome was complete resection rate, and secondary outcomes included en bloc resection rate, immediate and delayed bleeding, perforation, and procedure time. The Mantel-Haenszel method was employed for the analysis of binary endpoints, while the inverse variance method was used for continuous outcomes. Subgroup analysis was performed to explore potential sources of heterogeneity. Six studies involving 15,296 patients and 17,971 polyps were included in the meta-analysis. CSP had a significantly lower complete resection rate compared to EMR (OR: 0.44, 95% CI [0.21-0.94], p = 0.0334). However, there was no significant difference between CSP and EMR in en bloc resection rate, perforation, or procedure time. Interestingly, CSP had a significantly lower delayed bleeding rate compared to EMR (OR: 0.45, 95% CI [0.27-0.77], p = 0.0034), but there was no significant difference in immediate bleeding rate. In conclusion, CSP is a safe, efficient, and effective technique comparable to EMR. The choice of technique should be based on the individual patient and polyp characteristics.

| S-EPMC11663405 | biostudies-literature

Safety of cold snare polypectomy with periprocedural antithrombotic agents for colorectal polyps: a systematic review and meta-analysis.

Project description:BackgroundWe aimed to study the safety of cold snare polypectomy (CSP) for colorectal polyps in patients administered periprocedural antithrombotic agents.MethodsWe searched the PubMed, Embase, and Cochrane Library databases through June 2021. The primary outcomes were the rates of delayed and immediate bleeding (requiring endoscopic hemostasis). Secondary outcomes included thromboembolic events. Meta-analysis using odds ratios (ORs) and corresponding 95% confidence intervals (CIs) was performed to compare the outcomes.ResultsSeventeen studies, including five randomized trials, were included. Over 96% of polyps were ⩽1 cm. The pooled rates of delayed and immediate bleeding for patients receiving CSP and periprocedural antithrombotic agents were 1.6% and 10.5%, respectively. Both the delayed (OR = 4.02, 95% CI = 1.98-8.17) and immediate bleeding (OR = 5.85, 95% CI = 3.84-8.89) rates were significantly higher in patients using periprocedural antithrombotic agents than in non-users. Although both antiplatelet agents and anticoagulants increased the risk of delayed bleeding, the risks associated with the use of direct oral anticoagulants (DOACs; 2.5%) or multiple agents (3.9%) were particularly high. Compared to their counterparts, diminutive polyps and uncomplicated lesions not requiring hemoclipping were associated with lower risks of delayed bleeding (pooled estimates of 0.4% and 0.18%, respectively). Thromboembolic risk was similar among patients using and not using periprocedural antithrombotic agents.ConclusionsCSP with periprocedural antiplatelet agents and warfarin may be feasible, especially for diminutive polyps. However, drug discontinuation should be considered with the use of DOACs or multiple agents which entail higher bleeding risk even with hemoclipping.

| S-EPMC8841916 | biostudies-literature

Mechanism behind reduced resection ability of bent snares during cold snare polypectomy.

Project description:Accidental bending of the snare sheath occasionally occurs during cold snare polypectomy (CSP). We aimed to demonstrate whether snare bending reduces resection ability and, if it does, what causes this reduction. Using currently available CSP snares and prototype snares, we investigated changes in the resection ability of bent snares as well as the stiffness of their sheaths and wire spindles. Furthermore, to evaluate the performance of the bent snares, we measured the completion rate of CSP for 5-mm-diameter pseudo-lesions on the porcine rectal mucosa. Snare bending significantly decreased resection ability and wire spindle stiffness. Compared with bending the snares once, bending the snares five times further decreased the resection ability and wire spindle stiffness. A strong correlation was observed between wire spindle stiffness and resection ability after snare bending (correlation coefficient = 0.82; P < 0.001). Additionally, snare bending reduced the completion rate of CSP. Bending a CSP snare causes decreased wire spindle stiffness, thereby reducing its resection ability and potentially lowering the resection completion rate. The resection ability cannot be restored; therefore, snare replacement is recommended.

| S-EPMC11681012 | biostudies-literature

Effectiveness and safety of thin vs. thick cold snare polypectomy of small colorectal polyps: Systematic review and meta-analysis

Project description: Not available

| S-EPMC10798846 | biostudies-literature

EUS of a submucosal lesion at the appendiceal orifice using a double-balloon endoluminal intervention platform

Project description:Video Video 1 Video demonstrating the use of a DEIP to facilitate both radial and linear EUS in the proximal colon.

| S-EPMC10020377 | biostudies-literature